非传统理念指导下的传统技术导致应用医学重大课题的突破--关于2005年诺贝尔生理学或医学奖

发现幽门螺杆菌(Helicobacter pylori,以下简称Hp)导致慢性胃炎和消化性溃疡,是沃伦和马歇尔获得2005年诺贝尔医学奖的原因.他们在1982年得出的这一假说,违反了关于这一类慢性病传统的发病机制理念.可能因为这一理念的反传统性,其假说被世界同行基本接受大概经历了20年时间.值得强调的是,对HP的观察、分离、培养、鉴定和人体试验,以及它与疾病相关的诊断、治疗、临床流行病学等研究,应用的都是传统的医学技术.从而表明,即使到了20世纪80年代,传统技术仍能导致诺贝尔奖级科研成果的出现.     

Growing Up Can Be Painful: A Case Report of the Bat Mitzvah and Chronic Pain

Among a subgroup of adolescents with chronic pain syndromes, anxiety about “growing up” appears common and may be exacerbated by developmental transitions. Using the bat mitzvah ceremony as one example of a developmental rite of passage, we present two cases in which adolescent girls facing this transition developed new chronic musculoskeletal pain syndromes or experienced recurrences of pain symptoms. In both cases, the transition to adulthood, symbolized by the bat mitzvah, was associated with anxiety in adolescents who were unusually focused on the negative aspects of becoming independent adults. The aims of this case report are (1) to highlight the role of developmental transitions as a possible factor in the biopsychosocial model of pediatric pain; (2) to illustrate how to address emotional and cognitive responses to these transitions in the context of cognitive-behavioral treatment for pain; and (3) to suggest systematic approaches to investigating this clinically-observed phenomenon in future research.     

慢性前列腺炎的诊治思考

慢性前列腺炎是男科的中青年十分常见的疾病,其病因和发病机制尚未完全明了,严重影响患者的身心健康;随着慢性前列腺炎的诊治规范相继出台,有利于规范慢性前列腺炎的诊治;中医药对慢性前列腺炎的治疗有一定的优势,但仍存在许多问题,应进一步建立中医药对慢性前列腺炎的诊治规范,本文探讨中外对前列腺炎的诊治方案,特别强调中西医结合治疗慢性前列腺炎的良好疗效。     

Religiousness, Health, and Health Behavior in Public-Use Data of the National Center for Health Statistics

Studies of religiousness and health-related variables in large, population-based cross-sectional or, preferably, longitudinal studies, which are often prohibitively expensive, are important to complement findings from the more commonly performed studies. Inadequately known among social science researchers, the national health surveys of the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS) offer large, high-quality data sets to the public at no or nominal cost and hence offer important opportunities for research in the area of religion and health, religion and reproductive behavior, sociology of religion and psychology of religion. This report provides an overview of the data sets and a bibliography of prior research using these data, which is intended to suggest how the data of NCHS may be further exploited by researchers of religiousness and health.

干扰素治疗慢性乙型肝炎管理策略初探

在慢性乙肝抗病毒治疗中干扰素作为一线治疗取得了一定的疗效。在治疗过程中通过选择合适的慢性乙肝患者、监测疗效、确立个体化的疗程和剂量、及时监测不良反应和恰当的处理和最大限度的提高患者的依从性可使干扰素的疗效达到最大化。     

以信息增益模式探讨在高维数据上的多类别证型分类

在慢性胃炎研究上决策树归纳法之使用已渐增加,以决策树归纳法同时表示信息增益以区别胃炎症状对证型分类之贡献,能更正确地区别慢性胃炎。而信息增益已广泛地用于评估两分分类,仅有很少报导有关多类别慢性胃炎分类,它需要探索多类别慢性胃炎分类之信息增益。本研究提出基于名目及次序样本类结果的决策树归纳法所做的多类别慢性胃炎分类,例如,不同慢性胃炎次型的症状样本,评估是以决策树归纳法与Friedman-Goldszmid,HGC,Cheng判别法之正确率作比较。显示平均正确率64.9%优于前三者且提高1.55%。     

情绪通路异常与认知情绪偏差:慢性痛与抑郁症共病的神经心理机制

慢性疼痛与抑郁症具有高度共病性,但迄今尚无成熟理论能够阐释二者共病的神经心理机制。对慢性痛与抑郁的脑机制研究提示,慢性痛和抑郁常常涉及到相似的情绪脑区活动的异常改变;与此相对应的是,行为学研究发现,疼痛患者与抑郁患者在加工疼痛或抑郁相关信息时表现出了模式相似的认知情绪偏差(CAB)。近年来,越来越多证据趋于一致,指出慢性痛和抑郁共有的情绪通路异常变化可能导致了相似的信息加工异常,是二者共病的神经心理基础,而认知情绪偏差则在行为上反映了这种变化,并且很可能是共病发生、发展及维持的重要因素。     

Self-appraisal and coping in out-patients with chronic disease

Self-appraisal, coping efforts, muscle function, and activity and severity of disease were examined in out-patients with rheumatoid arthritis, osteoarthrosis or diabetes mellitus. Factor analysis of a 31-item self-appraisal and coping questionnaire yielded eight factors (self-appraisal, acceptance, minimization, planful problem-solving, avoidance, persistence, attribution of responsibility, and support seeking). For the factors of avoidance, minimization, and persistence, as well as for measures of activity and severity of disease, significant differences between the diagnostic groups were found. For patients with rheumatic arthritis, hierarchical regression analysis indicated disease duration to be associated with acceptance and with attribution of responsibility, and disability measures to be associated with self-appraisal. For patients with osteoarthrosis, they showed disability in muscle function to be associated with avoidance, and more negative self-appraisal as well as lower levels of support seeking to be associated with long disease duration. Results are discussed in terms of structural and adaptive defence forms and of adherence to a coping model ("medical model") which tends to foster acceptance and dependency.     

A Couple-Based Psychological Treatment for Chronic Pain and Relationship Distress

Chronic pain impacts individuals with pain as well as their loved ones. Yet, there has been little attention to the social context in individual psychological treatment approaches to chronic pain management. With this need in mind, we developed a couple-based treatment, “Mindful Living and Relating,” aimed at alleviating pain and suffering by promoting couples’ psychological and relational flexibility skills. Currently, there is no integrative treatment that fully harnesses the power of the couple, treating both the individual with chronic pain and the spouse as two individuals who are each in need of developing greater psychological and relational flexibility to improve their own and their partners’ health. Mindfulness, acceptance, and values-based action exercises were used to promote psychological flexibility. The intervention also targets relational flexibility, which we define as the ability to interact with one’s partner, fully attending to the present moment, and responding empathically in a way that serves one’s own and one’s partner’s values. To this end, the intervention also included exercises aimed at applying psychological flexibility skills to social interactions as well as emotional disclosure and empathic responding exercises to enhance relational flexibility. The case presented demonstrates that healthy coping with pain and stress may be most successful and sustainable when one is involved in a supportive relationship with someone who also practices psychological flexibility skills and when both partners use relational flexibility skills during their interactions.